A doctor caused an unborn baby to be accidentally decapitated inside her mother’s womb while performing a delivery, a medical tribunal has heard…

The obstetrician at Ninewells Hospital in Dundee is accused of wrongly going ahead with a vaginal labour in spite of several complications that meant a Caesarean delivery would have been safer because the premature infant was in a breech position.

The 30-year-old patient’s baby boy died during childbirth. Dr Laxman was suspended by NHS Tayside in the wake of the incident in March 2014.

How could something so hideous have happened? It appears that in the midst of an life threatening emergency, the obstetrician resorted to a last ditch procedure appropriate in a low resource setting instead of an immediate C-section.

The baby deserved every reasonable attempt to save its life; instead it was dismembered.

The woman’s waters had broken early at 25 weeks and upon examination her unborn baby was found to have a prolapsed cord, was in a breech position while the mother’s cervix was around 2-3cm dilated. It can be 10cm when fully dilated.

The prolapsed cord posed an immediate threat of death to the baby. That’s because the umbilical cord goes into spasm in room temperature air, cutting off blood supply and therefore oxygen to the baby. The baby must be delivered immediately by C-section to save his life. Although the mother was in labor, the cervix was not dilated enough for the baby to pass through. Furthermore, premature babies in the breech position are at even higher risk of injury from a vaginal birth than term babies. That’s why C-section is almost always recommended for premature breech babies.

But what if you’re in a setting where you don’t have access to a C-section and the baby is dying? In that case, you might use Durhssen’s incisions to cut open the cervix and allow the baby’s trapped head to come through.

Three surgical incisions of an incompletely dilated cervix, corresponding roughly to positions at 2-, 6-, and 10o’clock,used as a means of effecting immediate delivery of the fetus when there is an entrapped head during a breech delivery.

The use of Durhssen’s incisions carries serious risks for the mother including hemorrhage, injury to the urinary tract and the possibility of incompetent cervix leading to second trimester miscarriage in subsequent pregnancies. That’s why they’re reserved for situations in which an immediate C-section cannot be performed.

In contrast, this situation was a hideous case of malpractice. According to the mother:

I remember them saying I was two to three centimetres dilated and I was told to push. Nobody said I was not having a c-section and doing something else instead. Whilst this was going on I was in pain.

… I had the doctors putting their hands inside me and I had them pushing on my stomach and then pulling me down.

I tried to get off the bed but they pulled me back three times and just said they had to get the baby out. They twice tried to cut my cervix and nobody told me they were going to do it. There was no anaesthetic. I said to them ‘it doesn’t feel right, stop it, what’s going on, I don’t want to do it’ but nobody responded to me in any way.

Apparently the obstetrician pulled on the baby’s legs until the baby’s head detached inside the uterus. The details are nearly beyond belief:

They tried to coerce the birth through traction as the baby was coming feet first followed by the lower abdomen, upper abdomen and head,” lawyer for the General Medical Council Charles Garside QC said.

“However, there was an obstruction during the birth which proved to be fatal. Dr Laxman allegedly delivered the legs, torso and arms successfully but whilst trying to deliver the head, it got stuck in the cervix.

“The attempt to manipulate the baby’s head to come out of the cervix failed because the cervix has clamped onto the baby’s head and despite effort made to assist, these efforts failed. Dr Laxman made three attempts to cut the cervix with scissors but Baby B’s head was separated from his body and his head was stuck inside Patient A’s body.

“The doctors had to arrange for the head to be removed. A Caesarean was then carried out – not by Dr Laxman who had become overcome by events – but by Dr C and Dr D, and his head was removed in that way.

“As a matter of compassion the head was reattached so the appearance of the baby was not too extreme. The baby was shown to his mother so she had the consolation of seeing him.

I cannot image what the obstetrician was thinking. I wonder if she is mentally ill because I can’t find a remotely logical explanation for this entirely preventable tragedy. That’s does not mean that the baby would necessarily have lived. Cord prolapse is often fatal, and extremely premature infants face monumental risks. But the baby deserved every reasonable attempt to save its life; instead it was dismembered. And that doesn’t even count the horror that this mother had to endure and cope with for the rest of her life.

If the facts are as presented in the newspaper accounts, this doctor should never practice again.

Horrific. Sadly this will make the homebirthers so happy–“See? See what a doctor did?” UGH

Sarah

As there appears to be only one operating theatre at Ninewells Hospital, some of us wondered whether it was already in use, as the prospect of not being able to access the theatre to do a section for some time might perhaps have been a relevant factor in Dr Laxman’s decision. She’s giving her evidence today, and hasn’t mentioned any lack of operating theatre access. It would appear then that a section could have been performed.

Abi

I’ve just read a piece about this in the Daily Mirror – looks like she is citing ‘not having enough time’ to do a caesarean and that it would have been a difficult procedure that she felt would not result in a live birth.

Does anyone know if this is likely given the facts we have? (breech delivery, 4 cm dilation according to the defendant, and premature?) As others have said, this would seem more plausible if the baby had already made it through the cervix to any extent prior to the intervention but it seems that this wasn’t the case?

I suppose at that gestation there’s the argument that whatever you do stands a good chance of not resulting in a live birth, but if that were the case then you prioritise the mother’s safety and future fertility.

Tanu

I think instead of jumping the gun we need to see the facts .

RCOG says ( 2017)- Women should be informed that caesarean section for breech presentation in spontaneous preterm labour at the threshold of viability (22–25+6 weeks of gestation) is not routinely recommended.

Now she obv attempted vaginal delivery through an incompletely dilated cervix as there was a cord prolapse . She did try to give durhassens incision fretboard giving NTG . In an emergency there is usually less time to communicate to the patient in detail what’s happening leave alone providing analgesia .

I think the doctor tried her best to deliver vaginally and we have to remember in hindsight and retrospectively it’s always easier to blame .

The trauma the mother went through cannot be belittled in any way but this is definitely not an open and shut case .

Amy Tuteur, MD

The mother wanted a C-section. That should have stopped any attempt at vaginal delivery. The doctor should NEVER have pulled on the baby’s body. There is no situation in which that is an appropriate way to handle a live baby.

Tanu

Yes , but I can always imagine a scenario where the legs are out and cord is dangling and where rushing to theatres would take 5-10 minutes where in the baby would have just died, unfortunately.

Like I said it’s always easy to judge retrospectively and I seriously doubt the Doctor was meaning any harm. At best she was trying to deliver the baby in the quickest time possible.

Amy Tuteur, MD

The baby might have died anyway but it wouldn’t have been decapitated. There is no possible situation in which this was the correct response.

Tanu

No body anticipated the baby to get decapitated obviously. If we all knew the unseen complications insurance companies would have drowned themselves . We live in a highly charged environment where we apply the best of our knowledge and understanding , with experience to achieve optimum outcome. In life it just doesn’t happen always. Lynching somebody by saying pre term breech needs C section ( when the guidelines where she practices clearly says – at threshold of viability cesarean for breech is not acceptable ) shouldn’t be done. Facts should be visited with a clear mind without taking into account public hysteria .

Amy Tuteur, MD

The public’s thinking is irrelevant to me. My view reflect what I have been taught and what I have experienced as an obstetrician. Why are you trying to defend the indefensible? You are a doctor; are you a personal friend of the obstetrician in this case?

Tanu

People who’ve had experience with pre term breech will know that quite often the buttocks and legs prolapse through an incompletely dilated cervix . To do a cesarean section in such a situation – body hanging below and head stuck above would really be anybody’s nightmare .

MaineJen

You think an OB with 20+ years of practice has no experience with pre term breech?

The Computer Ate My Nym

They were in the delivery suite, not the ER or outside the hospital. A decision-to-incision time of 5-10 minutes is not acceptable for a hospital in a moderate sized city in the developed world. If that scenario is correct, it partially explains the decision to try for vaginal delivery, but says hideous things about the hospital.

fiftyfifty1

“A decision-to-incision time of 5-10 minutes is not acceptable..”

You’ve seen it done in less? The decision is made, the woman is wheeled down the hall into the OR, the docs scrub in, the belly is sterilized, the woman is put under GA, the incision is made…all in under 5 minutes??!!!

Sarah

Whether or not the doctor tried her best to deliver the baby vaginally isn’t the issue the GMC will be confining themselves to, and nor should it be.

Amazed

No one said that the doctor cackled evilly, anticipating the joy of decapitating a baby. ASAIK, no one ever thought of accusing her of intention to do harm, so I don’t see why you’re defending her on this count at all.

Sarah

Yeah, if there were any suggestion this were at all deliberate, she’d be facing a lot more than a professional body hearing. The Crown Prosecution Service would be involved. And they’re not. The police investigated and never charged her.

PeggySue

True, there was not time to communicate. But the mother, according to reports, was expecting a C-section and was horrified that that was not taking place. And it seems she had been in hospital for at least a few hours by then, expecting to have a section. She had been told a few days prior that baby was breech.

Tara Coombs Lohman

On the floor where I worked, we had a patient who came in for delivery of a fetus who had died in utero. She was about 22 or 23 weeks. The baby was breech and was decapitated during the delivery. One of my co-workers had to suture the head back on so the parents could see and hold the baby. She was so traumatized by the experience. I absolutely cannot imagine anyone having to go through this with a baby that was alive when the process was started. How horrifying for everyone involved.

guest

It really comes down to this: women shouldn’t have to beg for C-sections.

Another ugly case of fetal decapitation during an attempted vaginal delivery happened a few years ago in Missouri, except in that case the baby was full-term and head-down. The mother had requested a C-section from the beginning, knowing that she was high-risk, and was refused one.

I find it interesting that in both cases, the women were also denied pain relief or sedatives.

FFS, what purpose does it serve to make women suffer needlessly?

(Let’s set Dr. and Mrs Sears opinions about making women pay for the sin of Eve aside for a moment, and rephrase the question)

What reasonable, scientifically-backed purpose does it serve to make women suffer needlessly?

No woman should be forced to put her child’s life at risk for a vaginal delivery. And when you consider the mother’s health, the rate of ceasarean complications is unlikely to be as high as the rate of complications in vaginal childbirth.

Mishimoo

One of the articles about it mentioned that this was the first pregnancy for this poor mother. So it’s not just that her cervix was incomplete, it was also unproven. Adding the age of the foetus into the mix, with all the risks breech birth entails, and I am shocked it was even attempted.

There was a story in the London tabloids that indicated other doctors were present and horrified, even warned the doctor attempting the delivery to be careful, but no one demanded she stop and proceed to section. Not very helpful. But what a horrific story.

They’re just as culpable, then, because they didn’t step in and prevent her doing a procedure that she should not have done.

Sarah

For the medics, what would one expect to happen there if this is as stupid a course of action as it sounds? Just because of the posts about culpability of other clinicians. Like are you expected to try and physically prevent someone, and to what extent? Get hold of a superior? My worries there would be assault charges and the possibility that me not being there while I try and ring someone more senior further reduces the possibility of a good outcome.

I can’t speak for anyone but myself, but seeing as the general goal is to have a healthy baby and healthy mum, I’d personally err on the side of diving in and trying to stop the wrongness.

I think they had a duty to the patient, and they failed. They should have called for a supervisor, or stepped in and physically removed the one doctor if necessary. Just about anything but standing there and watching, or holding the patient down. That last is what clinched it for me — they’re just as liable as she is, as they actively participated in the abuse of the patient.

Daleth

I completely agree with you there, on every point.

Abi

This is what has shocked me more than anything actually, not that there was one incompetent, stupid, dangerous individual present – but that others actively participated.

I mean, even if there has been a miraculous outcome here this would SURELY be an open and shut assault case. Or am I missing something and there is some exception to the normal laws around consent that come into play during births? Is there some appeal to “not of sound mind” during labor because the patient is usually insensible with pain? I have to wonder because the only other time this happens is when a patient is sectioned under the MHA.

Sarah

The account of the other clinicians present is that they tried to dissuade her and told her it was going to kill the baby.

Like how useful is saying “careful” going to be anyway? While Dr Laxman exhibited awful judgement as to tge mode of delivery, I’m pretty sure she would’ve tried to extract the baby as carefully as she could. Which wasn’t good enough.

Platos_Redhaired_Stepchild

Why do I suspect that it will come out that either the doctor, the hospital, or the parents will turn out to be hard-core “natural” birthers?

Daleth

Because who else would even try to deliver a 25-week preemie vaginally, through a barely dilated cervix? Rational human beings would look at that situation and go, “Ok, time for a c-section.”

OB FL

I usually agree wholeheartedly with everything you post. And if the events here happened the way the media is reporting, then I still do. However, as an OB, I can imagine a situation where, with a few minor variations in the story (25 week breech PTL followed by ROM, cord prolapse, most of the body in the vagina at presentation, low resource facility where anesthesiologist is at home, long time since ROM where you are concerned for this extreme preemie’s intact survival if you wait the 20-30 min to mobilize a team to do a stat section and balance that against a very difficult classical section with implications for future deliveries and little likelihood of moving the needle toward intact survival for this baby, everyone moving rapidly leading to a pretty dramatic chain of events where the patient rightly feels traumatized by totally appropriate emergent OB care). We have one side of this story which admittedly sounds like malpractice the way it’s presented by the patient’s recollection. We do not have the physicians side of this story. The two sides are often vastly different and if appropriate debriefing is never done, then they are often difficult to reconcile. I’m all for weeding out bad docs. But let’s get both sides of the story before we judge.

Anna

I do have to agree. I have heard of a story where something like this happened in Australia. The Dr made a terrible mistake and a baby died as a result. He became suicidal, he had to take a long time off and go through extensive therapy to be able to return to practice. After everything I’ve been through – going from arrogant NCBer thinking all OBs evil, to realising the incredible responsibility they carry every day, with the potential for a tiny lapse in judgement to have horrific outcomes, I do think we have to be careful about gathering the lynch mob without knowing all the details. Maybe she panicked and pulled too hard, maybe she thought there wasn’t time for a section, maybe she thought the baby was right there and going to come easily – who knows. Its just so bloody awful. Drs and midwives are people and can be wrong. I hope the parents get a huge compensation either way because they’re going to need a lot of therapy and I hope they can get through it.

Who?

The only okay outcome here would be any lessons learnt that could be, and survivors getting what they need to be as okay as they can be in this terrible situation.

Anna

Yes. I know a woman whose baby died as a result of a hospital stuff up – a hospital homebirth program. She never got any proper apology or compensation and the hospital tried to say “well you wanted to do it, you consented” – yeah but the bloody midwife never turned up! They sold her the rosy story and didn’t give her any warnings about what to do in an emergency – even though they knew she had a history of fast births. The hospital implemented new protocols for every element of what went wrong – but still claimed no wrongdoing on their part. Its a shitty outcome for them family but theres some consolation in policy put in place to make sure something like that cannot happen again. 9 times out of 10 thats what bereaved families want – an apology, an acknowledgement and steps made to stop it happening again.

Sarah

It’s true we don’t have the other side to the story, but I can’t see that this is a low resource facility. It happened at Ninewells Hospital in Dundee, which is a decent sized city, and the hospital itself is a teaching hospital for a well rated medical school. They also have both an MLU and a CLU. That said, the website only mentions one operating theatre, so I guess it’s always a possibility that it was in use and going to remain so for a while longer.

Psychae

I am also horrified by this story and I can’t imagine what the parents are going through. I have colleagues who know some of the staff involved (not the obstetrician, but the anaesthetist who was there and some of the others) and those staff are also traumatised. As a GP obstetrician myself I find it really hard to see why things unfolded the way the newspapers say, because as Dr. Amy says, it doesn’t make clinical sense. A CS in that scenario is complicated but definitely doable (not to say I have any desire to be in that situation!). But I do think before we judge the obstetrician too harshly, we should probably wait and get all the information – the media are obviously latching onto such a sensational story but we don’t know if it’s all been reported exactly accurately…and we haven’t heard from the surgeon about her decision making process either. Maybe the mother refused a Caesarean (just pulling a scenario out of the air, but it’s happened to me – cord prolapse and the mother refused all interventions). It wouldn’t be the first time someone refused a procedure and then (genuinely or conveniently) couldn’t recall the conversation afterward.

If everything happened as reported, this certainly was malpractice – I’m not trying to mitigate that. But I think we should wait for all the info.

Anna

This too.

blargh

The mother had in her notes that even if she had a full term birth she needed a C-section and she was all for it. She definitely didn’t refuse the section.

Kim

This is an incredibly upsetting story. I too have been mystified as to why the obstetrician behaved as she did. It makes no sense. I also have no idea why she is defending herself at the GMC hearing rather than simply giving up practising: surely you wouldn’t want to go on after you’d done something like that?

PeggySue

I did a simple google search on “infant decapitated in childbirth” and got links to this case, of course, but to a number of others, some with similar-sounding circumstances, others seeming quite different. It may be that our notion that the decision for C-section was obvious does not match the way doctors are being trained? I dunno, but I was stunned that this ever happened, let alone many times.

Christina Maxwell

Here is a novel idea that is probably going to get me in all sorts of bother. How about we wait until all the evidence has been heard? It may well be that this OB has made a terrible error, about the worst she could have made. It may also be that there is more evidence to come. What if, for instance it turns out that not just the cord was prolapsed? What if it turns out that the legs were already out? Does that turn it into a judgement call rather than outright negligence?

FormerPhysicist

Fuck that. At 2 cm dilated, the legs weren’t out. I’m not an OB, but I know what size 2 cm is.
With this “let’s not judge without ALL the facts” you’re saying that only the jury on a full case can ever have an opinion.

I can judge decapitated babies and cervical incisions. I can judge hysteria and phobia about c-sections.

Christina Maxwell

Totally agree with you about the c section hysteria, a hysteria which is very prevalent at that particular hospital and in this particular health board area, to my great disgust. My youngest daughter was born there 27 years ago and things have not changed for the better since. We damn near lost her and it was only thanks to the NICU team that she was saved.
I make no mention of a jury as there isn’t one. What there will be, once this hearing is over is a full transcript of the whole thing available for anyone to read.

Sarah

Are you still familiar with the area in question? I’d heard of the hospital and was of course aware the Dundee medical school was good, but I didn’t know anything about specific local cultural factors. This of course raises the question of how much they were a factor too.

Amazed

Hmm, we have a good number of breech babies dying and being damaged because many someones made a wrong judgment call. We have a good number of babies dying and being damaged because many someones made the wrong judgment call of waiting for a 41-42 labour to start on its own. We have a good number of babies… so on and so on. A solid amount of data.

What we don’t have? A solid amount of data about decapitated severely preterm babies at 2 cm dilation. Because most people know it isn’t a matter of judgment call. It just doesn’t happen often enough.

Human babies grow disproportionally throughout their gestation. Newborns have big heads compared to their bodies – but they seem almost proportional compared to micropreemies. My 26 week son was shaped like a carrot – widest at the head, skinniest at the hips.

The CS would have been difficult since the baby would have to be threaded back through the pelvis and depending on how compromised the cord was it might have been too late – but he would have had a shot from a CS.

The other issue is that the OBs attempts at a total breech extraction would have likely caused other issues as well. C-section is a safer delivery method than vaginal vertex birth for babies under 33 weeks gestation because it reduces the risk of brain bleeds. A vaginal breech birth for a micro-preemie is contraindicated because the head is under extreme pressures in a direction the skull is less able to deal with so severe brain bleeds are possible.

BeatriceC

I’ve spent the last several days trying to construe a scenario where something like this could happen and it just be a horrific accident. The only thing I can come up with is if a woman presented to ER/A&E with the baby’s body already dangling through the partially dilated cervix and the hospital staff being unable to extract the baby via a crash CS fast enough, or baby’s head was stuck before the woman ever presented. If they had even five minutes to think about how to proceed, which they did because the woman had been admitted to the OB unit for some time already, there should have never even been a thought of an attempt at a vaginal delivery. That’s just standard OB care. You don’t deliver younger preemies vaginally if it can be avoided for reasons everybody else has already explained.

AnnaPDE

If you look at the original article, from the mother’s account that was clearly not the case. The problems had started earlier with the membrane rupture, she was being monitored, she’d been told a CS would be done when the baby needs to come out – and then she was allowed/made to labour and the doctors went for a vaginal delivery.

Amazed

Dear God. What did I just read?!…

Who?

It’s comforting sometimes to think that lessons can be learnt from bad outcomes.

Something as extreme and horrific as this though? Hard to imagine what the lesson might be, for anyone.

Amazed

Perhaps the lesson to obstetricians and maternity care providers as a whole is: Don’t freaking try this! But then, they already know. This OB is a distinct outlier.

The poor parents? I can’t imagine what their lesson might be.

Just horrible all around.

The Computer Ate My Nym

Has the OB made any statement about WTF she was thinking? Because this just does not make sense.

swbarnes2

Maybe she thought she could yank the baby out faster than the emergency C-section, because it was so small?

Amazed

If so, she has no place delivering babies. Vaginal delivery is tough even on full-term, average-sized babies. Subjecting a fragile 25 weeker to yanking and whatnot is downright barbaric. It can be understood of there are no other options available but this was not the case here.

Yesterday, I saw my friend with the 30 weeker in their first shot together (at the NICU). The baby’s head fits in about half of her mother’s palm – and that’s now, when she’s almost 5 pounds, eats from a bottle and is no longer in an isolette. I think it would be horrible if someone subjected her to a vaginal birth now, let alone at 25 weeks.

My son was born at 26 weeks. The resident who had charge of my care before my OB made it to the hospital checked to see his positioning before deciding if I was a candidate for a vaginal birth. I held my tongue until she realized he was breech and so would need a CS. If she had found him to be vertex, I’d have still pushed hard for a CS; a CS greatly reduces the risk of brain bleeds.

The risk of a catastrophic brain bleed from an emergency breech extraction in a 25 week infant must be exceedingly high.

I can’t believe she even tried it; neonates of that gestational age are mostly head with a tiny body and skin that is super-thin.

Amazed

My friend is careful to only show her baby from very up close in every pic. Literally all but three that I have seen are the baby’s head and the rest of her is under a blanket. The three exemptions were… upsetting, to put it kindly.

A 25 weeker? With a tiny head that looks huge compared to the rest anyway? Breech? You subject THIS to a vaginal birth?

I can see how that would feel that way. For me, micro-preemie pictures are now adorable. I’m not wishing a super-early birth on anyone – but watching the development of the baby over time is fascinating. Feeling my son’s teeny-tiny-itsy-bitsy fingers as he stretched his arms over his head and started exploring my collar bone while I held him is one of my favorite memories. (Well, that and our daily game of “how many testicles does he have descended today?”)

BeatriceC

My youngest looked like a drowned rat with a caricature cartoon head. He was a whopping 504g and 24 weeks. Micros just don’t look pretty to anybody but their parents, NICU staff, and other micro moms.

Amazed

Yes but we expect of obstetricians to know not just that they don’t look pretty but that OBs should preserve this big-looking (comparatively) but so terrifyingly tiny head from as much harm as possible. So fragile! In which world is this a good vaginal birth candidate? Or do we only consider if MOM can do it? Isn’t the baby kind of the end price and purpose to everything?

Obstetricians are the people I would expect to know this BEST.

Platos_Redhaired_Stepchild

The OB & medical facility likely can’t make a statement due to privacy laws.

Kim

It’s a GMC hearing to decide whether she will be struck off, so she will almost certainly be giving evidence in her own defence.

The Computer Ate My Nym

I wonder if the problem goes further than just one very very off the mark OB? Was she trained to believe that C-section should be avoided at all costs? Was the OR unlikely to be available immediately due to the hospital being underresourced? Was she unable to do c-sections because of poor training? This is someone who should not practice again, but are there other issues that need to be looked into to avoid future catastrophies?

Sarah

It’ll probably come soon, unless she has nothing to say at all. It’s a General Medical Council hearing so she will be able to give evidence herself as part of that, if she wants.

DaisyGrrl

I checked the General Medical Council website and the hearings are scheduled daily until the end of May.

Sarah

Which one can understand. I expect this is one of the bigger cases they have to deal with. Also, I’ll be interested to see whether any of the other doctors present have to go before the GMC either.

This is heart-achingly awful and should never have happened. My thoughts are with the mother and her family.

MaineJen

In what world???

The mom is only 2-3 cm. In what world do we decide to deliver vaginally? Particularly with all the tools of modern medicine at your disposal?

And the poor mom ended up with a c section anyway…to retrieve the head. UGH

StephanieJR

Jesus Fucking Christ, I’m into reading true crime and not usually one that’s put off easily, but I feel physically ill. That is pure high octane nightmare fuel. How absolutely horrible for everyone involved. That poor mother. I’m so angry at how in the hell this was allowed to happen. When you fucking decapitate a baby during labour, you sure as shit get as far away from medicine as possible.

I need to snuggle my bunny.

BeatriceC

Right? I was really glad to have not just one, but two umbrella cockatoos when I read that yesterday.

Ashley Ann

I like all of your posts, but I do not feel the last statement was appropriate: “I wonder if she was mentally ill….” That comment sounds to ableist and we don’t need to add to the stigma of being mentally ill.

mabelcruet

I agree-we can’t speculate on mental health issues here. I was thinking maybe she panicked, but given her age and assuming she started university at age 18 (like the vast majority of UK med students) and went through the standard post graduate obstetric training, she would have been working as a consultant for at least 5+ years (5 years at medical school starting at age 18, 2 years of foundation medical training, then 7 years of specialty training). It’s not like she was an inexperienced trainee out of their depth.

The article stated the OB was 41 years old so that’s 8 or 9 years of practice outside of training.

mabelcruet

I know quite a few O&G trainees do ‘out of programme’ secondment and sabbaticals, and some do higher degrees, MD etc or research. I’ve not found anything online about her qualifications, other than she is qualified and on the specialist register (same as American board certified), but she’s definitely a well established consultant. There were other doctors in the room at the time, and midwives, but none of them intervened. UK medicine is quite hierarchical so I wonder if they felt unable to intervene when a senior member of staff was there. But that goes against everything we’re taught about incident and error management-everyone is responsible and everyone needs to speak up .

PeggySue

There’s an article in another tabloid that says a midwife reported feeling she would have to physically assault the doctor to intervene, and did not feel she could/should do that. Who knows. It’s a tabloid, so…

Why didn’t the others present intervene? They had a duty of care to the patient, and they failed. Why is all the focus on the one doctor, when the others are equally liable?

AnnaPDE

Apparently someone warned her to be careful. Which might be the understated British equivalent of shouting “OMG what are you doing stop right now” and tackling someone, but clearly wasn’t that effective in practice.

I’m aware of the British penchant for understatement, but I think even there, this sitch would have called for quite a bit more than “Be careful.”

Abi

It probably is, to be fair. It would be fairly shocking in many fields for someone to say those words to their boss and would indicate that they were very concerned as to their conduct.

Amy Tuteur, MD

Ableist? On the contrary, I included it because it is a potentially mitigating circumstance.

Many people sent the original piece to me suggesting that it is an example of the inappropriate lengths to which some maternity providers will go to avoid a C-section. It doubt that. The obstetrician behaved in a bizarre fashion; there is no logical reason for her to have done what she did. It seems to me that in the face of bizarre behavior, it is worth asking whether the physician is impaired by mental illness or substance abuse.

You know, that doesn’t make it any less ableist. Most people with mental illnesses don’t decapitate babies.

LaMont

Most people *full stop* don’t decapitate babies. When people invoke mental illness, it isn’t because they think 50%+ of them are doing awful things, it’s because they’re alleging that mentally ill people are *disproportionately likely* to do them. That is the allegation that should be refuted – the strawman of “you think all mentally ill people are criminals” is unnecessary, and muddles the argument. You can say that invoking mental illness any time a bad act is committed is misguided, wrong, and harmful without it. Particularly since ideology and pure incompetence seem to cover this particular scenario.

(And do you think that mental incapacity shouldn’t be a mitigating circumstance in legal situations? I know lots of people agree with that, which is why so many people with mental illnesses are locked up rather than getting treatment, but that’s pretty rough. I’m not sure if you believe this but it’s a troubling enough viewpoint I’d like to push back on…)

“they’re alleging that mentally ill people are *disproportionately likely* to do these things”

Except for the fact that, you know, THAT”S FALSE. Mentally ill people are NOT “disproportionately likely” to decapitate babies. That, right there, is precisely what is ableist — the insinuation that mentally ill people are dangerous.

Beyond that, MI is no excuse, and not a mitigating factor here — she knew or should have known the correct procedure, and insisted on doing the other thing. Hold her fully accountable.

*sigh* Then why is LaMont so dead set on ablesplaining something that clearly I agree with?

fiftyfifty1

Because she wants you to be even more effective when you respond to people who are being ableist.

Now:
Ableist Person: “I wonder if she is mentally ill because I can’t find a remotely logical explanation for this…”
You: “Most people with mental illness don’t decapitate babies.”

Your reply is 100% true, but it’s a debate blunder because the original person can then reply with something like:
“I never said MOST people with mental illness decapitate babies. You are exaggerating because your feelings got hurt.”

The above debate has now been sidetracked. The ableist person continues to believe there was nothing wrong with what they said. They believe the only problem is that you are irrational and/or butt-hurt.

Here is what LaMont is suggesting instead:
Ableist Person: “I wonder if she is mentally ill because I can’t find a remotely logical explanation for this…”
You: It is ableist to hear a story of incompetence (or violence or ideological behavior etc.) and label the person mentally ill. Full stop.

Now the problematic thing that the ableist said is still front and center. They can’t deflect with complaints that you exaggerated what they said. That’s the point that LaMont was trying to make. Unfortunately in trying to make it she committed a debate blunder about 10X worse than your own– burying her point in the middle of an insulting rant about her “Major pet peeves.” Sheesh, LaMont, back to Rhetoric 101!

I was thinking about the narrow definition of ableism that Dr. Amy proffered and it’s just like saying racism is only thinking that people of another race are inferior to you. It ignores how people assume that every black person is out to burgle/rape/murder you, and that is obviously racism. Ableism is assumptions, bias and expectations of people with disabilities including mental illness. You can consider it an attitude based on pathological thinking which results in a negative stigma; like racism or sexism, it judges, labels, and limits.

Here’s a definition I got from online: Ableism is attitudes and practices based on the assumption that behaving in the ways of those who are not disabled is desired and best. It produces a system of privilege, thus resulting in stigma, bias, discrimination, and prejudice—in overt or covert ways against disabled people of all walks of life.

However, not everyone who is ableist (or racist or sexist) discriminates because they think they are better than others. Sure, some do. But heck, some don’t even realize that they are being discriminatory towards others. Ableism is also when someone is too lazy to someone, when they are ignorant about the disability, or see them as an inconvenience.

Associating mental illness with shitty behavior contributes to stereotypes that make it harder for people to get treatment. Heck, studies have shown that using the term mentally ill primes people to assume that the person described is inferior class requiring coercive handling and they are a threat to society.

Someone mentioned they did a search for babies decapitated during birth to see how common it was. I guess that all these doctors who screwed up so badly should also have been considered mentally ill for making these mistakes?

And of course, like all ableists, Amy felt that she had some kind of right to tell disabled people that we don’t know what ableism is, even though we live with it every damn day.

Mdstudentwithkids

I did not interpret Dr As post to say decapitating a baby was a malicious or evil behavior but a bizarre behavior considering her training and experience. If we interpret her behavior as bizarre then then there is reason to include psychosis as a possible explanation for her behavior.

*I personally strongly doubt she was actutely psychotic but we do not know all the details. I also understand the backlash to using the term mental illness to apply to bad behavior, especially in a public forum. But if someone starts acting extremely out of character (if we assume is the case here… it may not be), certain psychiatric conditions are certainly possible.

I agree 100%.
Dr. Tuteur says that she “can’t find a remotely logical explanation for this entirely preventable tragedy” other than deciding it must be mental illness. For her to be so singlemindedly stuck on mental illness as an explanation is bizarre because I can think of a bunch of reasons without barely trying:
1. Anti-CS ideology
2. Reaction to a medication she was prescribed
3. Incompetence pure and simple.
4. Returning to the workforce after a long absence and panicked.
5. Severe sleep deprivation. (Dr. Tuteur will surely disagree with this one as she has said in the past that in doctors professionalism can overcome the effects of sleep deprivation)
6. Drunk or high
7. Some scenario like OB FL outlines above.
8. We don’t have all the facts

And how! I did residency before work hour protections and during brutal rotations (in addition to long days every day) we could be up all night every 4th or even every 3rd night. At times I was so sleep deprived that I would fall asleep spontaneously if I was in a quiet room, and then when I awoke I did not fully wake. Once time the nurses told me about a problem and I started giving them orders as to fix it, and (according to what they tell) I started off giving normal advice and then it just totally veered into bizarre dream land gibberish. The only recollection I have of the event started with a very kind nurse saying something like, “Oh honey you must still be asleep. Come out to the nursing station, and we will fully wake you up and then I’ll ask you again.”

I still don’t know how I graduated high school on three hours a night.

fiftyfifty1

“But if someone starts acting extremely out of character (if we assume is the case here…it may not be), certain psychiatric conditions are certainly possible.”

See, that’s the problem. There are *a lot* of assumptions being made, and we have only media reports to go off of. And yet Dr. Tuteur jumps right to mental illness, is unable to come up with any other “remotely logical reason.”

People with mental illness, in my experience, have exactly zero problem with acknowledging that psychosis (and mania etc.) can and do cause bizarre behavior. What they have a problem with is what Dr. Tuteur did: being a bullshit armchair psychiatrist who decides that every action incomprehensible to them (whether evil or incompetent or extreme or violent or the list goes on…but always BAD) is just assumed to be “mental illness.” It is ableist.

LaMont

Right, I specifically did say that her comment was *also* false. Please don’t literally put words in people’s mouths, thanks.

And there IS a difference between “most people in Group X do Action Y” and “most/disproportionate Action Ys are done by people in Group X”.
When BOTH such allegations are false – AND BOTH ARE FALSE HERE – it gives ableist/racist/homophobic/what-have-you people an out when you engage them on the allegation they didn’t actually make. I’d rather not give them an out, but if I’m really such a harmful presence I can stay out of any and all discussions on best practices for taking apart harmful ideology.

I’m not putting words in your mouth, I quoted you verbatim. You absolutely ablesplained, and Amy DID throw those with MI under the bus.

Daleth

Except for the fact that, you know, THAT”S FALSE. Mentally ill people are NOT “disproportionately likely” to decapitate babies.

Mentally ill people are disproportionately likely to do bizarre things, i.e., things that make no sense to anyone and do not benefit anyone. If a man decapitated his own baby to avoid paying child support, we wouldn’t leap to the conclusion that he was mentally ill. Ditto if a woman decapitated her own baby to hide the evidence of her own infidelity.

But where there is no possible rational motive for doing something, and it’s something that no reasonable person would do, then yes, we do leap to the conclusion that the person who did it MIGHT be mentally ill. Because people with mental illness are indeed way more likely to do bizarre things that have zero benefit to anyone, not even themselves.

fiftyfifty1

“Ableist? On the contrary, I included it because it is a potentially mitigating circumstance.”

Try substituting in other groups that people believe are incompetent and/or dangerous to see if it still feels mitigating to you:

Decapitated baby? I wonder if the surgeon was female.
Decapitated baby? I wonder if the surgeon was Muslim.
Decapitated baby? I wonder if the surgeon was black.

Your IMMEDIATE LEAP to “oh, this isn’t normal, must be mental illness” is the problem here. You’re reinforcing the stigma against the mentally ill. THAT IS HOW IT’S ABLEIST.

(Khenarthi’s flight feathers, the fact that I have to explain this to a doctor…)

Amy Tuteur, MD

Ableism is the belief that the mentally ill are inferior; it is NOT the empirical fact that bizarre behavior is associated with mental illness. You are entitled to your opinion, but that doesn’t make it true.

NO. It is not just the belief that people with MI or other disabilities are inferior, it’s also in your words and actions.

When you immediately jump to mental illness as an explanation for bad behavior, you are implicitly signalling that you believe the mentally ill to be inferior whether you intend to or not. Your belief to the contrary is irrelevant, as is your dictionary definition.

Amy Tuteur, MD

The difficulty seems to be that you view what this doctor did as garden variety “bad behavior.” Given the fact that I practiced obstetrics and observed many obstetricians doing the same, I view her behavior as bizarre and not resembling obstetric principles in any way, shape or form. It is the bizarreness that makes me wonder if she is impaired by mental illness. You may see it differently; in that case, we’ll have to agree to disagree.

fiftyfifty1

No, she’s not using “bad behavior” to mean something small or garden variety. Her other posts indicate that she knows that what this OB did was above and beyond. She is using “bad behavior” as shorthand for situations like this. And her point is that if there are other potential explanations for “incomprehensible + bad” (and in this case there are) that it is stigmatizing to start speculating that it must be mental illness.

I realize I am not the most articulate person to try to explain this, and for that I apologize. If you are truly interested in learning why what you say is problematic for people with mental illness (as opposed to just interested in being defensive) I really recommend contacting NAMI. They are always super glad to sit down with people in the media (of which you are one) and explain this perspective.

Amy Tuteur, MD

If I’m truly interested in learning? Why do you assume I don’t have personal experience with mental illness? Just because I choose not to share the struggles of close family members with the general public doesn’t mean I’m not well aware of stigma.

That doesn’t change the fact that bizarre behavior includes mental illness high on the differential.

fiftyfifty1

Nobody is assuming anything about your personal and/or family experience. What we are saying is your language and assumptions are contributing to the stigma problem. I fully believe you when you say that is the opposite of your intentions. That is why I recommend NAMI. I have been taken aside gently but firmly myself on more than one occasion and had a blind spot pointed out to me.

Sometimes I wish some of the less-deluded parachuters would come to threads like these and realize that, although there’s usually agreement among the regulars, this blog is not an echo chamber packed with shills or sycophants.

Sarah

Yep. There can’t be many regulars here who haven’t had a full and frank exchange of views with Amy over something!

BeatriceC

Me. I’ve disagreed with her from time to time, but my confrontation anxiety is too bad for me to say anything. Notice how silent I am in this discussion. I certainly have an opinion, but I’m too damned scared to express it.

I’m working on that.

Sarah

I hadn’t noticed that actually, but I’m sure I can’t be the only one who’d be interested to hear what I’m sure would be well thought out disagreement from you when applicable.

Amazed

Far from the only one.

Empress of the Iguana People

Don’t really have an opinion here, but ibid in general

blargh

I have an opinion too but I’m also too anxious to argue it, and that stems from years of arguing with people over my rights and how I deserve to be treated. Dr. Amy’s response is the mildest type to get from people who don’t agree and I still can’t bring myself to argue it.

And secondly, WHAT ABOUT THE OTHER DOCTORS PRESENT AND SUPERVISING? Did they not have a duty to intervene when it was clear she was doing the wrong procedure? Are they all mentally ill, too?

Amazed

Bad behavior? I thought we all agreed it was unfortunate circumstances and a wrong decision. I didn’t see Dr Amy saying that the obstetrician must have aimed to decapitate the baby. I was under the impression that she was trying to help but something was awry.

BTW, love how intentionally decapitating a baby is bad behavior in your book. I thought a pre-schooler pushing his sister to the floor for no reason but being bored was bad behavior. The last thing I would call this tragedy is bad behavior.

Wow. You may need to re-read what I wrote, this time without your ableist lenses on.s

This WAS a tragedy — I never said otherwise! I’m just saying that, when there are incidents like this, or a mass shooting, for example, that the FIRST THING POINTED TO Is mental illness, because society has this idea that neurotypicals never ever have bad judgement or fuck up or commit violent acts.

When mental illness is your go-to explanation, you are directly harming those with mental illnesses by reinforcing the negative stereotypes that people with MI are violent/incompetent.

THAT IS WHAT I OBJECT TO.

Beyond that, regarding this specific case, I feel that the other doctors present had a clear DUTY to stop her from doing the procedure. Their lack of action means they are equally liable. This cannot reasonably be laid at the feet of one person, when others were supervising.

You’re ignoring the fact that there are about a zillion other perfectly reasonable explanations — including but not limited to panic, sleep deprivation, intoxication, or just plain stress — for why this doctor messed up.

And last, it’s highly unethical for you, or Amy, to fling about armchair diagnoses.

Daleth

When you immediately jump to mental illness as an explanation for bad behavior, you are implicitly signalling that you believe the mentally ill to be inferior

And that actually is associated with mental illness–it’s literally one of the defining features of mental illness. If you look at the criteria for any given mental illness, they always include something that boils down to “the person does or says things that make absolutely no logical sense and are not consistent with what their reality looks like to the rest of us.”

And that doesn’t mean mentally ill people are inferior. It just means they’re mentally ill.

Empress of the Iguana People

One of the questions on the paper I fill out for my shrink is “have you been talking/moving so slowly or so quickly that other people have commented on it?” Not a feature of my depression, but it must be a fairly common feature for it to be on that list.

Daleth

That’s an interesting example. And yeah, the basic point is, mental illness is usually visible to other people in the form of behaviors that range from a little weird to flat-out bizarre.

So it’s no more ableist to wonder if a person who did something completely irrational might be mentally ill than it is to wonder if a person with physical tremors might have Parkinson’s. It’s just literally one of the symptoms. And it doesn’t suggest that the person in question is inferior any more than wondering if they have Parkinson’s suggests they’re inferior.

Amazed

No, YOU are reinforcing the stigma against the mentally ill. It’s because of reflexive jumping like yours here that people don’t want mentally ill people living next to them. It’s because of reflexive jumping like yours here that the families refuse to notice that there might be a problem with their loved ones until it’s fucking late. Because bad behavior is one thing but doing bizarre things – oh, why think someone is mentally ill! Your fucking fear of admitting that bizarre behavior – like so bizarre that there isn’t even a meaninggul statistics of it – might be connected with being mentally ill is so NOT helpful.

Do you know who you remind me of? The way I’m told my grandmother reacted when my mom, her brand new granddaughter, she noticed bizarre behavior in her daughter, my aunt, and told her so, She got put down by the entire family as a nosy newcomer presuming too much. You know how it turned out? My aunt WAS and IS mentally ill. A few years later, even the family could not deny it any longer because she had an outright psychotic episode. They missed a period that might have made a difference because they spewed reflexive defensive, soothing, enabling shit like your, “Oh, it’s just bizarre behavior!”

fiftyfifty1

I see nothing that supports your assertion that WMDKitty is against early diagnosis and treatment of mental illness. People who advocate against the use of stigmatizing language can in no way be equated with family or community members who are in denial. I myself have been arguing against stigmatizing language here AND also I work at the government level to support and expand our state’s mental health services including our First Episode Psychosis program and residential treatment centers for adults and children who exhibit aggressive behaviors as a symptom of their illness. Neither WMDKitty nor myself have our heads stuck in the sand.

Amazed

Oh, I never claimed that WMDKitty is against early diagnosis and treatment. What I claim is that I can easily see how attitude like hers can convince people who already want to believe that the bizarre behavior have other reasons that mental illness should be on the very bottom of the page as possible reasons. What I find problematic is that in regards to this case, she doesn’t seem to admit that untreated mental illness can disproportionately impair judgment, especially when it’s new enough to not be noticeable in common circumstances. I am not saying that she – or you, of course – is burying her head in the sand, I’m saying that such attutude provides a nice bucket of sands for people inside the situation to bury their heads in.

On the other hand, I find this bordering close to such reflexive denial that people who aren’t in the situation are more likely to dismiss the valid concerns (and yes, the concerns about mentally ill people being perceived as more prone to violence are very valid) as well-meaning nonchalance about anyone else but the mentally ill.

Daleth

she doesn’t seem to admit that untreated mental illness can disproportionately impair judgment

I said that it’s UNREASONABLE TO JUMP TO THE CONCLUSION THAT SOMEONE IS MENTALLY ILL BECAUSE THEY HAD A LAPSE IN JUDGEMENT!

Daleth

Nobody is jumping to conclusions. Saying that someone MIGHT be mentally ill is not a conclusion that they are mentally ill.

Abi

But if you cannot see any plausible reason for bizarre behviour and you don’t actually know what the person’s mental state is, what else are you left with? Certain types of mental illness are undoubtedly a strong contender. Taking this to mean that all people with any mental illness are therefore suspect is just not logical thinking I’m afraid.

I agree that some form of mental impairment seems the likeliest explanation for what happened here – in the absence of any other evidence.

Amazed

I can’t really say that this case is best explained with mental impairment – I am not in the field. But since recently, I had an occasion where everyone around me thought it was an omission (a few omissions) and genuine mistakes and I knew it wasn’t because in my profession, there is just one kind of people who does this combination of omissions and mistakes, I am prepared to concede more insight to people who actually have knowledge in a field to know just how bizarre it was.

To this layperson, the only thing that is clear is that this seems like a monstrous step out of the boundaries of acceptable.

Second, I’m not denying anything. I know full well what mental illness can do to a person. I’m saying it’s unfair and hurtful when NT assholes like yourself blame anything and everything you think is “abnormal” as mental illness.

Amazed

You know? Nice to hear this. Because you certainly don’t seem to know much. You simply put things in Dr Tuteur’s mouth and now mine.

I am not going to try to defend myself from accusations that everyone can see are a blatant lie. Bye, liar.

ETA: Sorry about your pronouns. I live in a country where we aren’t as advanced as to focus on these problems, so this kind of correctness is something that doesn’t come naturally to me, unless I’m specifically aware that a person prefers them. I think I saw fiftyfifty1 referring to you as her and decided she must have had other exchanges with you and knows your gender.

And that, right there, is the typical ableist response, blaming the mentally ill for being stigmatized by neurotypical society. Victim blaming is ugly.

Amazed

Victim blaming? Hahaha.

Has it ever occurred to you that it isn’t that we didn’t understand that you’re mentally ill? You didn’t TELL us that you were. And now you’re trying to spin the fact that you chose to omit this bit of information as me blaming you, the mentally ill, for being stigmatized? Not going to fly, sorry.

Twisting your silence and trying to ascribe knowledge of things you chose to omit to other people to present yourself as a victim is ugly.

And yet, somehow, NTs get away with all kinds of bizarre behavior without being stigmatized… wonder why that is…

Daleth

Your IMMEDIATE LEAP to “oh, this isn’t normal, must be mental illness” is the problem here.

She said MIGHT be mental illness (which it very well might be), not MUST be. If a woman murdered her newborn baby, would you get mad if Dr. T “immediately leaped” to “oh, this isn’t normal, might be postpartum psychosis”? It’s NOT normal. It actually might be postpartum psychosis.

I respect your interest in making sure that mentally ill people aren’t stigmatized. But are you perhaps taking that a little far, to the point where you don’t want anyone to acknowledge what mental illness even is?

I don’t mean what it is in terms of brain chemicals, etc. I mean the symptoms that made human beings realize there was such a thing as mental illness in the first place, and led us to do research that turned up interesting differences in brain chemistry, etc.

In other words: the symptoms of doing or saying things that make no rational sense to anyone, and are harmful.

If you do something that makes rational sense but is harmful, that’s not mental illness but criminality (for instance, a burglar who steals things in order to get money–that’s rational from the burglar’s perspective). And if you do something that makes no sense but is harmless, then you’re a harmless eccentric.

But if, like my bipolar aunt, you bankrupt yourself by spending all your money on bizarre things that do nothing but turn your apartment into a health hazard, that makes no sense and is harmful (to you–most often the only harm mentally ill people inflict is on themselves). If you get so depressed you can’t function and consider suicide, even though you haven’t experienced any particular traumas and your life to that point was objectively pretty good, that makes no sense and is harmful.

If you can look in the DSMV and find a mental illness whose symptoms do NOT boil down to “Does, says or thinks things that make no rational sense and that are harmful,” I’ll buy you a beer.

Trans people’s symptoms do NOT boil down to “Does, says or thinks things that make no rational sense and that are harmful.”

BOOM.

I’ll take that Guinness, now.

Daleth

Trans people’s symptoms do NOT boil down to “Does, says or thinks things that make no rational sense and that are harmful.”BOOM.

Does it make rational sense for a person whose body is clearly male and who was raised/encultured as male to insist that they *actually are* a woman? Or vice versa?

And how do you conclude that there’s no harm in it, when the hallmark of gender dysphoria (and one of the listed symptoms) is significant DISTRESS about the mismatch between one’s physical and subjective genders? Is it harmless, when suicide is much more common among trans people than non-trans people? Per Wikipedia, a study of 6450 trans people found that 41% of them had attempted suicide, as opposed to 1.6% of the general population.

The current understanding of gender dysphoria is that it’s a mental disorder that is treatable by simply enabling trans people to live as the gender that they feel like they are. Maybe when society is more accepting of trans people, it will stop being harmful (e.g., the suicide rate will drop to something normal). Then maybe it will be reclassified as yet another harmless eccentricity, instead of a mental disorder.

“Does it make rational sense for a person whose body is clearly male and who was raised/encultured as male to insist that they *actually are* a woman? Or vice versa?”

Yes, because they *are* women. Or men. Or non-binary. It’s society that’s not making rational sense, insisting that genitalia somehow define a person.

blargh

You wouldn’t believe how many ableist doctors I’ve left in my life. If anything they seem less prepared than the average public to deal with disability, or worse at hiding it. I’ve pretty much defaulted into expecting ableism from any new doctor I see.

fiftyfifty1

“An ableist society is said to be one that treats non-disabled individuals as the standard of “normal living’…”

Exactly. Ergo when something occurs that is not ‘normal living’ (like a baby getting decapitated in a delivery) it can’t possibly be the actions of a non-disabled person, it just must be the actions of a mentally ill person!

In my experience, people with mental illness are very supportive of the idea that maternal infanticides* should be thoroughly investigated, and that postpartum psychosis should be high on the differential. Even so, they oppose speculation by the media and armchair psychiatrists. And they would especially oppose somebody implying that PPP was the only “remotely logical explanation.” Because there are actually a lot of non-PPP cases of maternal infanticide including concealed pregnancies, revenge against a spouse, non-desired sex of infant, losing your temper, and serial baby smotherers.

* note the terminology. since we don’t know why the baby was killed, it’s a maternal infanticide or maternal filicide not a murder unless proven to be a murder.

Daleth

Ableism is NOT suggesting that a person who behaves bizarrely might be mentally ill anymore than it is suggesting that a person who has trouble reading might have dyslexia.

EXACTLY.

Amazed

I fail to see how your comparisons are remotely relevant. I immediately inferred from Dr Amy’s post that she means undiagnosed mental illness. Meaning – untreated mental illness. Sorry but I really can’t see why this would make one exempt from muddled perceptions of things and subsequently, unsolicited actions.

Call me ableist all you want, fiftyfifty1, but untreated and not successfully treated mental illness might make someone incompentent and dangerous, IMO. And I’m saying this as someone who participated in the care of someone mentally ill because in our case, it makes her unable to care for herself.

fiftyfifty1

The problem is the immediate jumping to the conclusion that the person must be mentally ill if they do something that you find incomprehensible+bad. It’s the same stigma-spreading response that causes everyone to speculate that “It’s a Muslim” every time something goes boom. From Timothy McVeigh to the explosion at our local refinery, it was “The Muslims” until it wasn’t, and even then some people still think it was the Muslims.

It’s prejudiced and it hurts people. Can you imagine being a little Muslim kid who has to hear the speculation every time something happens? Do you think it makes their peers treat them with sympathy? Do you think they find it “mitigating”?

As for untreated/unsuccessfully treated mental illness sometimes leading to someone being incompetent and/or dangerous, like I said below, in my experience people with mental illness have exactly zero problem with that concept. If they have experienced psychosis/mania/severe depression etc and come out the other side, they can tell you first hand how debilitating mental illness symptoms can be. And yet they are all pretty universally opposed to people jumping to the “they must be mentally ill” conclusion every time something bad happens. I work on a large state task force where, by law, over half of the members live with chronic mental illness. This is something they 100% oppose, and organizations like NAMI work to educate the media.

(as a side note, let’s take a moment to notice how nobody ever jumps to “it must be mental illness” when something unusual + good happens. Big whopping donation to your alma matter? Big tip? I wouldn’t be surprised if a lot of these are fueled by a dose of mania, but do people ever speculate that mental illness should get the credit?)

Amazed

I didn’t see Dr Amy jumping to the conclusion that this obstetrician must be mentally ill. I saw her ask a question that perhaps was worth asking. As a layperson, I can’t really speak of outliers when we speak obstetrics. But even so, I know that these exact circumstances aren’t included as a significant reason for mortality. It looks too strange to me and yes, it’s worth asking if there is a problem.

Yes, I read what you wrote about your experience with people with mental illness. And I am under the impression that you’re talking about people who know they’re ill and their illness is controlled. Here, care for the mentally ill is sadly underpar which means that my experience, as someone who, more or less, moves in the world of such problems, is different. I have the dubious honour of seeing untreated mental illness. And mental illness which will not be treated for some years to come because it’s still mild enough for everyone to be in denial – if there is mental illness at all. But they won’t go to the doctor to find out. They just keep on with the bizarre behavior and the people around them keep enabling them, hoping that things would get better because if they don’t, the world they will all enter for sure is a bleak one. So yes, in Dr Amy’s place I would have also wondered if the obstetrician was mentally ill – early enough to be unnoticed, advanced enough to have their judgment impaired when the situation became really tough. Because that’s what my experience shows. I am constantly amazed at how convincing, charming, and reasonable my aunt can sound even now – and that’s after thirty years of ruined (politics and stuff) care for the mentally ill that in her case was delayed to begin with. I can totally see how someone can be mentally ill, not knowing it and not showing it.

If we don’t treat mental illness (especially undiagnosed and unadequately treated one) as a problem that can present objective difficulties with judment and assessment of a situation, we aren’t doing the mentally ill any favours. I mean, I won’t feel offended if I drop Amazing Niece, she hits her head, and my brother asks me, “Were you hobbling around again?” I know my old fracture is a problem, that’s why I don’t carry the kid when I’m hobbling around. It isn’t a stigma against the people with old, problematic fractures. It’s an objective problem.

What none of them understand is that I am mentally ill — ADHD, anxiety, a bit depressed, OCD, and PTSD.

I have an intimate understanding of just what it can do to ya head.

I also have an intimate understanding of how hurtful it is to be told that I’m scary, or a potential threat, every time some neurotypical goes off the rails and kills people.

fiftyfifty1

“how hurtful it is to be told I’m scary or a potential threat, every time some neurotypical person goes of the rails and kills people.”

And that’s so often how it goes. A person commits some heinous act of violence, the media speculates that the offender “must be mentally ill”, later the person is found to have no mental history at all but rather a long history of being a violent asshole. But what sticks in people’s head?—that the offender was mentally ill and mentally ill people are dangerous. This stigma is a real problem. Starting to experience symptoms of mental illness? Don’t go in for an assessment! Mental illness is for mass murderers and baby decapitators!

So that’s why it’s important not to speculate, and I’m pretty sick of people pretending that this is about political correctness, or bogus arguments that they are only “telling it like it is” or that their armchair speculations are somehow helpful (but advocates with mental illness don’t realize it..probably because they’re crazy after all!) snark

Amazed

But in this case, we aren’t taking about someone being scary, or a potential threat. We aren’t even talking about someone deciding to kill people. We’re talking about the possibility of impaired judgment in a set of very particular circumstances. I don’t see what it has to do with mentally ill people as a whole and this includes you. We aren’t talking about someone running about with a knife.

Me too though. And actually if I learned that the pilot of my plane had ADHD I’d be bloody terrified! Not least because I know what it’s like to have it.

Poogles

I am also mentally ill, and I have to agree with Dr. Tuteur and Daleth on this. In this particular context, I don’t find her comment to be stigmatizing; when I read that line, I just sort of nodded to myself and thought “definitely could be”.

Daleth

Call me ableist all you want, fiftyfifty1, but untreated and not
successfully treated mental illness might make someone incompentent and dangerous, IMO

It’s not just your opinion. Untreated or unsuccessfully treated depression (or the depressive phase of bipolar disorder) often leads to suicide. Untreated bipolar disorder in the manic phase can also get somebody maimed or killed through recklessness (deranged driving, ultra-risky sexual behavior, etc.). Any disease with hallucinations or severe delusions as a feature can certainly make someone incompetent as a driver, a parent, or [insert job here]. Etc.

I understand and respect the desire not to stigmatize people who are mentally ill. But some people seem to take that so far that they get angry when you even point out that mental illness can be dangerous, or even that it might in any way be inherently (i.e. not just because of stigma) a bad thing.

Amazed

“I understand and respect the desire not to stigmatize people who are mentally ill.”

That’s it. I used to feel stunned when I mentioned about my aunt’s diagnosis and get shocked stares, as if people felt uncomfortable on my behalf. As if I had unintentionally dropped the bomb. To me, part of not stigmatizing people who are mentally ill is to discuss the difficulties without turning away from them. Just like I discuss physical illness. And bizarre behavior and the increased potential of danger is there when the treatment isn’t working as it should or isn’t there to being with. Just like crossing the street in high traffic is more dangerous for me when my fractured foot is not OK and tends to give up when I least expect it.

Let’s remember what mental illness is. The very definition of it is, “Someone is saying or doing something that makes no sense to the rest of us and is harmful.” If you look in the DSM, every mental illness is defined by a list of symptoms that boil down to that.

Here’s what I mean in laypeople’s terms: Depression? Someone is really sad and can barely function, but it makes no sense because nothing terrible has happened to them recently–no deaths of loved ones, no apparent trauma, etc. Paranoid schizophrenia?
Someone is convinced, for absolutely no rational reason and with no evidence, that (insert delusion here, e.g., the FBI has them under surveillance and has implanted electronic monitors in their body). And so forth.

The aspects of mental illness that are visible to others are always somebody doing things that make no sense to the rest of us and that cause themselves, or sometimes others, harm.

This OB did something that makes absolutely no sense to his or her fellow OBs, or to the rest of us who know anything about childbirth. Nobody can understand why a doctor would insist on delivering a 25-week breech preemie vaginally through a barely-dilated cervix in the first place, much less why he would start tugging hard on its tiny helpless feet once it got stuck. There is just no rational basis for doing any of that, and obviously it caused the ultimate harm to both mom and baby. It will also no doubt destroy the doctor’s career. There’s just NO sense in it.

Hence the question: Was this OB mentally ill?

And as Dr. T has pointed out, if he was, that would actually be a mitigating circumstance because it would suggest he may not have been fully in control of his decisions and actions.

Amazed

I remember wondering why no one else in the world had this thing my aunt had. When I told the other kids that she was mentally ill, I got blank looks. No one knew what mental illness was and those who asked their parents after our conversation got told to keep silent and most of them, to stay away from me. For many years, people tried to pretend that mental illness was something that simply did not happen. Certainly not in their families. There were always other reasons to explain the unexplainable.

Framing mental illness as a protected category that should only be mentioned as a last possibility, no matter the circumstances, did not help anyone. Not me to understand. Not people to get treatment.

fiftyfifty1

So, in summary, you don’t see any problem with people in the media speculating about somebody being mentally ill whenever any bad behavior that they can’t understand occurs.

Nope. That’s not ok.

Daleth

any bad behavior that they can’t understand occurs.

I’m not sure why you’re not getting the difference between “bad behavior someone can’t understand” and “bizarre behavior that benefits literally nobody, including the person who did it, and makes no rational sense to anyone.” This is a much narrower category of behavior than “bad behavior.”

And we’re not talking about “people in the media.” We’re talking about an OB-gyn commenting on a bizarre medical decision made by a fellow OB-gyn. Dr. Tuteur’s education and experience qualifies her to confirm for the rest of us that this apparently bizarre and nonsensical behavior actually is bizarre and nonsensical.

fiftyfifty1

Dr. Tuteur is prominent in the media as an OB-Gyn. She is sought out to give comments and write opinion pieces in print, television and radio. This blog is well read for a medical blog.

And while her OB-Gyn training makes her well positioned to confirm when something is far outside the scope of normal care, her training in no way makes her armchair speculations in the field of psychiatry useful.

But let’s get down to the most important point:

Let’s say that this OB doesn’t turn out to be mentally ill. Who then will have benefited from Dr. Tuteur’s speculations? And who will have been harmed?

Let’s say that this OB does turn out to have a mental illness diagnosis, but not one that played any part in the care she provided. Once again, who will have benefited, who will have been harmed?

Let’s say that Dr. Tuteur’s prediction is correct, and this woman was suffering from psychosis during the delivery. Who will have benefited from Dr. Tuteur’s “see I told ya so!” prediction? Who will have been harmed?

I can’t think of a single scenario where Dr. Tuteur’s armchair psychiatry will have helped anyone, but I can imagine the harm whether she was “right” or not. There are already reader comments expressing pain and hurt. It’s irresponsible, and it is not best practices, ask NAMI and other advocacy organizations. Her doubling down on this reminds me so much of all the media organizations who initially refused to follow best practices re: suicide reporting…”But, but, but I can say whatever I want. But, but one of my own family members killed themselves, but but but…” It’s lame

Daleth

I can’t think of a single scenario where Dr. Tuteur’s armchair psychiatry will have helped anyone

It helps clarify just how radically outside the standard of care this doctor’s actions were. If an OB does something and another OB, in searching for any possible explanation, can only come up with “maybe she’s mentally ill,” that tells you just how far outside the bounds of reasonable medical care this was, and how absolutely necessary a c-section is in such cases (including future cases, for anyone who finds themselves in the same situation as this poor mother).

So it helps us understand the bounds of normal obstetric care and what doctors should do to protect breech extreme preemies. But that said, I don’t think there’s really a rule that we’re only allowed to speak if what we’re saying is helpful to someone.

fiftyfifty1

“If an OB does something and another OB, in searching for any possible explanation, can only come up with ‘maybe she’s mentally ill,’ that tells you just how far outside the bounds of reasonable medical care this was,”

Ah, so it helps us as readers know that this isn’t just “totally and completely outside the bounds of normal care” but rather Into The Realm Where Only The Mentally Ill Are Found. Well geez, now I understand! Too bad there is no possible other way to express how absolutely needed a CS was in this case other than stigmatizing an entire group of people. But actually, now I’m confused. What if she doesn’t turn out to be mentally ill? Then I guess it becomes just was normal non-standard care rather than ‘crazy care’?

Oh, but we’re expected to just suck it up, and take the blame for the stigma, because we do “bizarre” things…

fiftyfifty1

I don’t think there’s really a rule that we’re only allowed to speak if what we’re saying is helpful to someone.”

You are 100% right, there is no rule. That’s why it’s also no problem to speculate that it was the Muslims whenever something goes boom.

Abi

I’ve had anorexia and I would not be remotely offended by someone saying ‘maybe she has anorexia’ as a possible reason why a woman who looked very skinny and had not been observed eating in a number of months had fainted at work. That’s not the same as saying anorexia and careers don’t mix, it’s just a possible explanation for what happened.

Sure, there are occasions where such a ‘diagnosis’ definitely WOULD offend me. For example, if someone who was naturally thin but otherwise perfectly healthy was described as such behind her back. Or if a doctor saw it on my notes from 20 years ago and wrongly assumed unexpected weight loss was because I’d stopped eating again rather than a sign of something more serious and did not look into it (this has happened).

But where there are NO OTHER OBVIOUS REASONS for someone’s actions, and there are strong reasons for them NOT to behave as they did such as professional codes of conduct and the most fundamental principles of their specialism, you can only make assumptions based on available evidence. Yes, these are assumptions. But in this case I think it was reasonable to ASSUME that (a) however rabidly anti C-section a doctor is they don’t kill a baby by trying to deliver a preemie in this way, (b) however under-funded the NHS may be, emergency provision is a strength and emergency surgery is prioritised and (c) we have evidence from witnesses that suggests bystanders were as confused as we are.

Mental impairment of some sort then becomes a very real avenue of enquiry. I really don’t know why this is so hard for some people to grasp.

Daleth

That’s a great example. And in addition to not meaning “anorexia and careers don’t mix,” it also doesn’t mean anorexics are inferior to non-anorexics. It just means that anorexics are more likely than non-anorexics to never eat (and thus never be seen eating), be extremely thin, and faint (because extreme hunger can make people faint).

I’m not sure why a couple of posters here think that pointing out that people with X diagnosis are observably different than people without X diagnosis means you’re saying such people are inferior.

Azuran

I really don’t get why they are so worked up over considering someone might have a mental illness. Seems to me that talking about it is good and might help other people in the future. If you see someone at work who seems to be struggling with something, and can be a danger to herself or other, it would be bad if no one dared to point it out because they feared being accused of judging them or calling then inferior.
We had cases at my clinic, in the past few years we had 2 vets who’s quality of care dropped. They started not being able to keep up with medical records, taking longer to work cases, started having more complications and stuff like that. So of course we started getting worried and look into it. One of them ended up just being lazy and not caring, he was promptly fired and reported for malpractice. The other one, we thought she was having mental problems, even though we don’t have the knowledge to diagnose her, she was just generally acting weird. We put her on sick leave, and referred to a professional to work on her mental state. And now she’s back with a special schedule adapted to the need of her diagnosed mental health condition and she is a perfectly capable vet.
We shouldn’t go around and calling everyone who does something bad ‘mentally ill’ and try to dismiss everything that happened as just the deeds of a deranged person. But there is nothing wrong about wondering about the mental state of someone when they show behaviour that might be compatible with some kind of mental illness.
And having mental illness doesn’t mean they are inferior or anything.

fiftyfifty1

Once again, we have exactly zero problem with investigating bad behavior at work or anywhere else. If someone’s professional performance is unacceptable, PLEASE put that person on leave immediately and investigate fully, just as you did!

But please DON’T put up a blog post saying what Dr. Tuteur did which was “I wonder if [they] are mentally ill because I can’t find a remotely logical explanation”

Instead be professional and do a good investigation (just as apparently you did.) Get all the facts. Don’t jump to conclusions. Because why should a whole group of people have to bear the stigma of (per your own example) a vet whose malpractice was actually due to being lazy and not caring?

Daleth

I think you’re right. It’s much more helpful to be able to talk about mental illness, to be able to acknowledge that it might be what’s happening to someone you know. How else are we supposed to understand it, or understand how prevalent it is, or help people who are suffering from it?

fiftyfifty1

In each of your 3 examples your concern rests with making sure that people don’t bear the “stigma” of being labeled as mentally ill unless they really, in your opinion, deserve to have that label. You believe a naturally thin woman should be offended if others speculate her thinness could be due to mental illness. You yourself, despite your documented medical history, were offended that a doctor put it at the top of his differential when you lost weight.

Can you not see how completely 180 deg opposite this is to the concerns that Ashley Ann, WMDKitty and I have raised? Our concerns are not that the OB will be “stigmatized” by being called mentally ill when she doesn’t “deserve it.” Our concern is that an entire community of already stigmatized people will be further stigmatized by having horrific actions pinned on them with zero proof.

The fact that you (and apparently Dr. Tuteur as well) confound those 2 types of stigma is yet another example of ableism.

fiftyfifty1

“bizarre behavior that..[..]..makes no rational sense to anyone.”

Except apparently for the other medical professionals who were in the room at the time. Wow, they must all have been psychotic! These dang mentally ill people, they are everywhere, watch your back!

Daleth

The news reports I saw, which have been discussed on this thread, say that the other medical professionals in the room at the time warned the doctor that she might kill the baby. So I’m not sure where you’re getting that.

Why do you respond to my posts only to address something in your head rather than something I wrote? You made a sarcastic remark about others in the delivery room saying “be careful.” That’s a straw man that you made up. I didn’t say anything about people saying to “be careful”; I said, in black and white, that per the news reports they had warned the OB that she might kill the baby.

So, I understand that this is all severely triggering for you, and I’m sorry that’s the case. If you want to keep ostensibly responding to my posts while actually responding to things you made up in your head, I can’t stop you, but I’m not sure what anyone is getting out of the time you spend doing that.

You’re saying that “behaviors that don’t make sense” are “mental illness”.

By your own standard, EVERYBODY is mentally ill, because EVERYBODY does stuff that makes no logical sense.

Daleth

Do you want to just agree to disagree? I understand that this topic is a big trigger for you, to the point that you’re–I can’t tell which–either unwilling or unable to understand what I’m actually saying. That “by your own standard…” bit in your post is a straw man; you’re arguing with yourself, not me, since the points you’re arguing against are not the points that I made.

Charybdis

Damn near everything my Asperger’s brother does doesn’t make sense to me, nor does the INTENSITY of his reactions to inane things. I was writing with a blue ballpoint pen one time and he completely melted down over the fact that I was using a BLUE BALLPOINT pen instead of a BLACK FELTTIP pen, which is what HE prefers.

In my more charitable moments, I will put this down to personality quirks. Other times, not so much.

Just because it doesn’t make sense to you doesn’t mean it’s “abnormal”.

Charybdis

I know it made sense to *HIM*, but a full-on, flapping, grimacing, pacing and biting meltdown due to me writing with a blue ballpoint pen is pretty incomprehensible to me, as it was to the other folks who were present for the incident. It was a very strange reaction to a extremely minor, inane thing that had nothing to do with him. So yeah, it was abnormal.

His brain is wired differently than other people’s, so he reacts to things differently. He has odd body language and flat speech affect. If you met him, he might strike you as “a bit odd”. He would probably fall further out on the edges of a bell curve of so-called “normal” behavior. A standard deviation or three off of the mean. His behavior is abnormal, HE is not.

My nervous system is wired differently, as I have migraines and IBS. My oversensitive brain and nervous system results in auras, loss of vision in one eye, allodynia, nausea, brain fog, sensitivity to light and sound, and finally, the searing, pulsating, throbbing, stabbing head pain. I really don’t consider that to be “normal”. I would consider it to be on the outer reaches of a bell curve, a standard deviation or two away from the mean.

Just as I don’t understand my brother’s intensive, sometimes violent responses to inane things (pen color, sandwich cutting, the flapping and biting, etc), I really don’t expect others to understand my migrainous response to artificial sweeteners, flashing or flickering lights, barometric pressure changes, stress, etc. My nervous system is more sensitive and will overreact to some stimuli, so I think of myself as having abnormal reactions. Am *I* “abnormal”? I think the jury is still out on that.

Empress of the Iguana People

holy fu…………
what a nightmare

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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